Healthcare Provider Details

I. General information

NPI: 1255777454
Provider Name (Legal Business Name): ADRIANA LETICIA CRAWFORD RTC, CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

4881 VISTA DR APT 4
HUNTINGTON BEACH CA
92649-3557
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-4952
  • Fax:
Mailing address:
  • Phone: 714-849-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: